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. 2023 Mar;12(1):100922.
doi: 10.1016/j.imr.2023.100922. Epub 2023 Feb 3.

Addressing cancer-related fatigue through sleep: A secondary analysis of a randomized trial comparing acupuncture and cognitive behavioral therapy for insomnia

Xiaotong Li  1 , Kevin T Liou  1 , Susan Chimonas  2   3 , Karolina Bryl  1 , Greta Wong  1 , Eugenie Spiguel  1   4 , Susan Q Li  1 , Sheila N Garland  5 , Ting Bao  1 , Jun J Mao  1
Affiliations

Addressing cancer-related fatigue through sleep: A secondary analysis of a randomized trial comparing acupuncture and cognitive behavioral therapy for insomnia

Xiaotong Li et al. Integr Med Res. 2023 Mar.

Abstract

Background: Fatigue is a troublesome symptom in cancer survivors that often results from disrupted sleep. We sought to assess whether two insomnia-focused non-pharmacological interventions are also effective for improving fatigue.

Methods: We analyzed data from a randomized clinical trial comparing cognitive behavioral therapy for insomnia (CBT-I) versus acupuncture for insomnia among cancer survivors. Participants were 109 patients who reported insomnia and moderate or worse fatigue. Interventions were delivered over eight weeks. Fatigue was evaluated at baseline, week 8, and week 20 using the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF). We used both mediation analysis and t-tests to explore the extent to which fatigue reduction was attributable to insomnia response.

Results: Compared to baseline, both CBT-I and acupuncture produced significant reductions in total MFSI-SF scores at week 8 (-17.1 points; 95% confidence interval [CI]: -21.1 to -13.1, and -13.2 points; 95% CI: -17.2 to -9.2, respectively, all p<0.001) and week 20 (-14.6 points; 95% CI: -18.6 to -10.6, and -14.2 points; 95% CI: -18.1 to -10.3. respectively, all p<0.001), with no significant between-group differences. MFSI-SF total scores at week 8 were significantly associated with sleep improvements in both CBT-I and acupuncture groups (p<0.001 and p=0.011, respectively). Insomnia responders demonstrated significantly greater improvements in mean MFSI-SF total scores compared with non-responders in the CBT-I group (p=0.016) but not in the acupuncture group.

Conclusion: CBT-I and acupuncture produced similar, clinically meaningful, and durable fatigue reductions in cancer survivors with insomnia, primarily through improvements in sleep. Acupuncture may also reduce fatigue through additional pathways.

Keywords: Acupuncture; Cancer; Cognitive behavioral therapy; Fatigue; Insomnia.

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Figures

Fig 1
Fig. 1
Consort Diagram. Abbreviation: PROMIS-GHS-fatigue, Patient Reported Outcomes Measurement Information System-Global Health Scale-fatigue item.
Fig 2
Fig. 2
Mean Change in MFSI-SF Over Time. Abbreviations: CBT-I, cognitive behavioral therapy for insomnia; MFSI-SF, Multidimensional Fatigue Inventory-Short Form.
Fig 3
Fig. 3
Proportion of Responder Rate by MFSI-SF at Week 8 and Week 20. Abbreviations: CBT-I, cognitive behavioral therapy for insomnia; MFSI-SF, Multidimensional Fatigue Inventory-Short Form.
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